Box-ticking and Olympic high jumping – Physicians’ perceptions and acceptance of national physician validation systems

<b>Purpose:</b> National physician validation systems aim to ensure lifelong learning through periodic appraisals of physicians’ competence. Their effectiveness is determined by physicians’ acceptance of and commitment to the system. This study, therefore, sought to explore physicians’ perceptions and self-reported acceptance of validation across three different physician validation systems in Europe. <b>Materials and methods:</b> Using a constructivist grounded-theory approach, we conducted semi-structured interviews with 32 respiratory specialists from three countries with markedly different validation systems: Germany, which has a mandatory, credit-based system oriented to continuing professional development; Denmark, with mandatory annual dialogs and ensuing, non-compulsory activities; and the UK, with a mandatory, portfolio-based revalidation system. We analyzed interview data with a view to identifying factors influencing physicians’ perceptions and acceptance. <b>Results:</b> Factors that influenced acceptance were the assessment’s authenticity and alignment of its requirements with clinical practice, physicians’ beliefs about learning, perceived autonomy, and organizational support. <b>Conclusions:</b> Users’ acceptance levels determine any system’s effectiveness. To support lifelong learning effectively, national physician validation systems must be carefully designed and integrated into daily practice. Involving physicians in their design may render systems more authentic and improve alignment between individual ambitions and the systems’ goals, thereby promoting acceptance.

**研究背景：** 国家医师执业认证系统（physician validation systems）旨在通过定期评估医师执业能力，保障其终身学习。系统的有效性取决于医师对该系统的接纳程度与投入意愿。因此，本研究旨在探究欧洲三种不同医师执业认证系统下，医师对认证的认知与自我报告式接纳情况。

**材料与方法：** 本研究采用建构主义扎根理论法（constructivist grounded-theory approach），对来自三个执业认证体系差异显著的国家的32名呼吸科专科医师（respiratory specialists）开展半结构化访谈（semi-structured interviews）：德国采用以继续专业发展（continuing professional development）为导向的强制性学分制体系；丹麦实施强制性年度沟通及后续非强制性配套活动；英国则推行基于个人档案的强制性再认证体系（portfolio-based revalidation system）。本研究对访谈数据进行分析，旨在识别影响医师认知与接纳程度的相关因素。

**研究结果：** 影响接纳程度的因素包括评估的真实性、考核要求与临床实践的契合度、医师的学习理念、感知自主权以及组织支持力度。

**研究结论：** 系统的有效性取决于使用者的接纳程度。为有效保障终身学习，国家医师执业认证系统需经精心设计并融入日常临床实践。邀请医师参与系统设计，可提升体系的真实性，优化个人职业诉求与系统目标间的契合度，进而促进医师对系统的接纳。